Diabetes mellitus (DM) is one of the major diseases in the world that pose a serious threat to human health, with a prevalence up to 10% and about 50-60% of DM patients dying of macrovascular and microvascular complications. Diabetic retinopathy (DR) is one of the most important pathological changes in microvascular complications of diabetes, currently ranking top 1 among the causes of blindness and vision disability. How to delay the occurrence and development of DR has now become the focus of attention and research in the medical field. One of the important pathogenesis is microcirculation disturbance. From the perspective of whole-course control of diabetic retinopathy, drugs, laser, surgery and other integrated means are its treatment options. Early diabetic retinopathy is a key part of Chinese medicine intervention, which, especially with macular edema, causes central vision loss, making DM patients more painful than DM itself. Rational use of traditional Chinese medicine can delay the development of diabetic retinopathy and intercept early macular edema, having an advantage in maintaining visual acuity. Although diabetic macular edema has always been a difficult point of ophthalmic treatment, it is undeniable that traditional Chinese medicine has played a great role. Through clinical observation and experimental research, we make full use of the “translation platform” and explore the mechanism of action of traditional Chinese medicine to provide objective basis for clinical medication and application.
In view of the pathogenesis of diabetic retinopathy, the etiology and pathogenesis recognized by Chinese medicine experts is “deficiency in origin and excess in superficiality”. “Deficiency in origin” means that most of the DM patients go through yin deficiency and dryness heat in the early stage, deficiency of both qi and yin in the middle period, and deficiency of both yin and yang in the late period; “excess in the superficiality” is manifested as “qi stagnation and blood stasis” persists throughout the microvascular pathological change. Diabetic retinopathy usually occurs at about 10 to 20 years after the occurrence of diabetes mellitus, and “deficiency of both qi and yin, qi stagnation and blood stasis” is the major pathogenesis. According to the pathogenesis of DR, the treatment should focus on activating blood circulation to dissipate blood stasis by solving ocular fundus microaneurysm, minor hemorrhagic foci, hard exudates, edema and other signs to “treat the symptoms”; for those with systemic deficiency of qi and yin, both the symptoms and root cause should be addressed by focusing on supplementing qi and nourishing yin and activating blood circulation to dissipate blood stasis. Based on the above basic principle, lots of studies about DR have been conducted, including comparison of different symptom patterns and experimenting the effects of different therapeutic principles on retinal microangiopathy. However, these studies are not standardized or systematical enough, having different drawbacks.